Composite Veneers and a New Upper Denture

A Creative Smile and Bite Reconstruction by Dr. Chris Nelson in Redding, CA

This was one of those cases where the “standard” treatment plan was not necessarily the best treatment plan.

Our patient came into Nelson Family Dental with a full upper denture and lower teeth that were severely worn down. In the before photos, the lower front teeth are barely above the gumline. The upper denture teeth were also very flat and worn from years of function.

At first glance, one possible solution would have been to place crowns on the lower teeth and make a new full upper denture. That would have worked in some ways, but it also would have been more aggressive, more expensive, and maybe not as kind to the new denture over time.

So we paused and thought through the case carefully.

One of our core values at Nelson Family Dental is “Success in the Sandbox.” To me, that means we are not trying to force every patient into the same treatment plan. We are trying to use the tools, experience, creativity, and technology available to us to find a solution that actually fits the patient in front of us.

In this case, that meant rebuilding the lower teeth with composite veneers / composite bonding and then making a new full upper denture to match.

The Starting Point: A Worn Denture and Lower Teeth Worn Nearly Flat

This patient had two main problems happening at the same time:

Her existing full upper denture was very worn down. The denture teeth had become flat from years of use. Her lower teeth were also severely worn. Some of the lower front teeth were barely above the gumline, which meant there was very little natural tooth structure left to work with visually. When the upper and lower teeth are both worn down, the bite can collapse. The teeth no longer support the face, chewing becomes less efficient, and the smile can start to look shorter, flatter, or older. This was not just a cosmetic dentistry case. This was also a bite reconstruction case.

Why We Did Not Automatically Crown the Lower Teeth

Originally, I was thinking about restoring the lower teeth with crowns. That is a common way to rebuild teeth that are worn down.

But then our financial coordinator, Kristi, brought up a very reasonable question:
Could we use composite bonding on the lower teeth instead of crowns?

My first reaction was basically, “Probably not.” But after thinking about it, it actually made a lot of sense. A full upper denture is made with denture teeth, which are essentially a type of resin or acrylic material. If we placed a full set of very hard ceramic crowns on the lower teeth, those lower crowns could potentially wear down or damage the upper denture teeth faster. So instead of putting very hard ceramic against denture teeth, we decided to match the materials more intelligently. The upper denture teeth would be resin/acrylic denture teeth. The lower teeth would be rebuilt with composite resin.

That gave us a more forgiving material-to-material relationship and allowed us to restore the smile without preparing every lower tooth for crowns.

The Treatment: Composite Veneers on the Lower Teeth

For the lower teeth, we used a composite bonding technique that functioned almost like direct composite veneers. This was not just “freehand filling material.” We used a planned workflow.

We had Forrister Dental Lab in Shasta Lake create a wax-up of the lower arch. That wax-up served as the blueprint for the new tooth shapes. From there, we made a clear matrix so we could transfer that plan into the patient’s mouth. Then we rebuilt the lower teeth tooth by tooth with composite resin. The amazing part of this case is that the lower composite veneer work was completed without dental anesthetic. No shots were needed for this part of the treatment. The process took a couple of hours, and we scheduled enough time to work carefully through the case. Once the lower teeth were rebuilt, we made a new full upper denture to match the new lower tooth position, smile shape, and bite.

The Result: A Restored Bite and a More Natural Smile

The final result was a dramatic improvement. The lower teeth were restored to a more normal length and shape. The new upper denture was made to fit the rebuilt lower teeth. The bite was opened back up, the smile looked fuller, and the patient had a much better chewing relationship between the upper denture and lower teeth. Most importantly, the patient was very happy. This was a case where being a little creative made a big difference. We were able to give the patient a nice result while avoiding a much larger and more expensive lower crown plan.

Why This Case Matters

There is not always one “right” way to fix worn teeth.

Some patients need crowns.
Some patients need implants.
Some patients need dentures.
Some patients need a combination of all of the above.

But in this case, composite bonding and a new denture gave us a really nice balance of function, appearance, cost, and invasiveness.

That is the kind of dentistry we enjoy doing at Nelson Family Dental: careful, deliberate, patient-specific dentistry that tries to solve the actual problem without making the plan bigger than necessary. :-)